Dysrhythmias/Conductive Disorders

Dysrhythmias/Conductive Disorders

1. Brady

   • atrial
     • rate<60
     • "sinus"
       • upright P in I, II, III, aVF
     • CAUSES
       • AV node blockers, sedatives, opiates
       • athlete
       • pathologic
   • Junctional
     • AV junction
     • rate 40-60
     • no P
     • causes
       • myocarditis
       • CAD
       • Dig tox
       • norm
   • ventricular
     • rate 20-40
     • wide complex
     • causes
       • cardiomyopathy
       • usually pathologic
       • ischemia
       • hypothermia
       • med tox
       • electrolyte disorders
   • Treat
     • if unstable
       • atropine, pacer
     • ventricular
       • pacer

2. AV block

   • 1st
     • 1P for 1QRS
     • PR> .2 sec
     • rarely treat
       • Cause
         • age
         • meds
         • myocarditis
         • ischemia
   • 2nd
     • Mobitz 1/Wenkeback
       • Causes
         • norm
         • inf. wall ischemia
         • transient
       • PR increasing until dropped QRS
       • P to P constant
       • narrow QRS
       • treat w/ atropine, pacer
     • Mobitz 2
       • P to P constant
       • PR constant
       • occ. dropped QRS
       • can progress to 3rd HB
       • below AV node
       • wide QRS
       • ant. MI
       • Rx pacer
   • 3rd
     • P-P constant
     • variable PR
     • constant QRS
     • ant MI
     • inf MI
     • Rx: pacer
   • BB can cause

3. Tachy

   • Narrow & regular
     • Supraventricular tach (SVT)
       • hidden or follow (retrograde) QRS
       • wide or narrow
       • regular
       • CAUSES
         • thyroid
         • PE
         • Sympathomimetics
       • RX: vagal maneuvers,adenosine, AVN blockers, type 1a meds/amiodarone, cardiovert
         • NO mix CCB &BBs
     • Aflutter (2:1)
       • sawtooth
       • 2 P for 1 QRS
       • look all leads
       • CAUSES
         • CHF
         • COPD
         • ischemic HD
         • ETOH use & w/d
         • thyroid
     • Sinus tach
       • 1P for 1QRS
       • CAUSES
         • thyroid
           • hypovolemia
         • anxiety
         • pain
         • fever
         • PE
         • ischemia
         • hypoxia
       • treat the cause
       • NO SHOCK
   • max sinus rate = 220-age
   • narrow & irregular
     • Afib
       • no reg atrial activity
       • CAUSES
         • CHF
         • COPD
         • ischemic HD
         • ETOH use or w/d
         • thyroid
       • most common chronic tach
     • A flutter variable
       • regular atrial (F-waves)
     • multifocal A tach
       • P irregular, >3 diff morphologies
       • CAUSES
         • theophylline tox
         • Pulm dx
           • COPD
           • asthma
           • pneumonia
       • Rx underlying cause
   • wide & regular
     • sinus tach w/ aberrant conduction
       • P waves
     • Vtach
       • P hidden
       • *rate >120*
       • CAUSES
         • Ischemia
         • Cardiomyopathies
         • hypoxia
         • severe electrolyte disorder
     • SVT w/ aberant
       • BBB
       • WPW
         • NO CCB
       • P hidden
       • always treat as VT
     • Procainamide, Cardioversion

4. wide & irregular

   • Afib w/ BBB
     • rare >200bpm
     • QRS identical
     • CCB,Digoxin
   • Afib w/ WPW
     • poss vent rate 300bpm
     • QRS morph varies
     • SHOCK
     • procanimide

5. Torsades de pointes

   • rapid regular & wide
   • QRS changes amp & shape
   • ischemic HD
   • QTc >500
   • CAUSES
     • hypo K+
     • hypo Mg+
     • hypo Ca++
     • Na+ channel block med
     • inc ICP
     • hypothermia
     • Congenital

6. Vfib

   • rapid, disorganized
   • no pulse
   • *DEFIB*
   • CAD, electrolyte disorders

7. Treat cause

   • How based on
     • dec. LOC, CHF, Ischemia, HypoTN

8. emergent treat based on vent rate

9. hyperK

   • Peaked T waves

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